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| | style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Serum sickness | | | style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Serum sickness |
| | style="background: #F5F5F5; padding: 5px 5px;" valign=top | ▸ Urticaria, arthralgia, fever | | | style="background: #F5F5F5; padding: 5px 5px;" valign=top | ▸ Urticaria, arthralgia, fever |
| | style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Heterologous]] [[antibodies]], [[infliximab]] | | | style="background: #F5F5F5; padding: 5px 5px;" valign=top | [[Heterologous]] [[antibodies]], [[infliximab]] [[Cefdinir]] [[Bupropion]] [[Levothyroxine]] [[Moxifloxacin]] [[Tetracycline hydrochloride]] [[Antivenom]] [[Glatiramer acetate]] [[Antivenin]] [[Measles]] [[Ticlopidine]] [[Clopidogrel]] [[Novobiocin]] [[Epinephrine]] [[Omalizumab]] [[Rituximab]] [[Immunosuppressive drug]] [[Digoxin]] [[Levothyroxine]] [[Ciprofloxacin]] [[Cefprozil]] [[Cefaclor]] [[Oxacillin]] [[Amoxicillin]] [[Penicillin G benzathine]] [[Ampicillin]] [[Ceftibuten]] [[Cefpodoxime]] [[Terbinafine]] [[Gemifloxacin]] [[Metronidazole]] [[Cefadroxil]] [[Doxycycline]] [[Levofloxacin]] [[Minocycline]] [[Moxifloxacin]] [[Sulfadiazine]] [[Lincomycin]] [[Sulfamethoxazole]] |
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| | style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Drug reaction with eosinophilia and systemic symptoms (DRESS) | | | style="background: #DCDCDC; padding: 5px 5px; font-weight: bold;" valign=top | Drug reaction with eosinophilia and systemic symptoms (DRESS) |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2], Jolanta Marszalek, M.D. [3]
Overview
The types of drugs that can cause drug allergies vary. Drugs containing sulfa are common in causing drug allergy reactions. Other common drugs implicated in leading to an allergic reaction are antibiotics, insulin, and iodinated drugs.
Causes
Common Causes
When a medication causes an allergic reaction, it is called an allergen. The following is a short list of the most common drug allergens
- Antibiotics
- Analgesics
- Anticonvulsives
Causes by Organ System
| Cardiovascular
|
No underlying causes
|
| Chemical / poisoning
|
No underlying causes
|
| Dermatologic
|
No underlying causes
|
| Drug Effect
|
Abciximab, Acetazolamide, Albuterol, Allopurinol, Amifostine, Barbiturates, Benazepril, Bendamustine,Benoxaprofen, Betaxolol, Bisoprolol, Brentuximab vedotin, Brimonidine, Brinzolamide, Budesonide And Formoterol Fumarate Dihydrate, Bumetanide, Buprenorphine Hydrochloride, Naloxone Hydrochloride, Cabergoline, Captopril, Carbamazepine, Carteolol, Carvedilol, Cefdinir, Celecoxib, Cephalosporins, Cetuximab, Chlorambucil, Chlormezanone, Chlorothiazide, Chlorthalidone, Clindamycin, Codeine, Diclofenac, Diltiazem, Doxycycline Hyclate, Erlotinib, Ethotoin, Etravirine, Exenatide, Fosamprenavir, Gold, Ibandronic acid, Ibritumomab tiuxetan, Interferon beta-1b, Ipilimumab, Insulin, Isoniazid, Lamotrigine, Leflunomide, Lenalidomide, Methyldopa, Methylphenidate, Nebivolol, Nevirapine, NSAIDs, Penicillamine, Phenacetin, Phenobarbitol, Phenylbutazone, Phenytoin, Primidone, Procainamide, Quinidine, Sorafenib, Streptomycin, Sulfacetamide sodium And Prednisolone acetate, Sulfasalazine, Sulfonamide, Sulfonylurea, Suramin, Terbinafine, Tetracycline, Thiabendazole, Thioacetazone, Vancomycin, Vandetanib, Zonisamide
|
| Ear Nose Throat
|
No underlying causes
|
| Endocrine
|
No underlying causes
|
| Environmental
|
No underlying causes
|
| Gastroenterologic
|
No underlying causes
|
| Genetic
|
No underlying causes
|
| Hematologic
|
No underlying causes
|
| Iatrogenic
|
No underlying causes
|
| Infectious Disease
|
No underlying causes
|
| Musculoskeletal / Ortho
|
No underlying causes
|
| Neurologic
|
No underlying causes
|
| Nutritional / Metabolic
|
No underlying causes
|
| Obstetric/Gynecologic
|
No underlying causes
|
| Oncologic
|
No underlying causes
|
| Opthalmologic
|
No underlying causes
|
| Overdose / Toxicity
|
No underlying causes
|
| Psychiatric
|
No underlying causes
|
| Pulmonary
|
No underlying causes
|
| Renal / Electrolyte
|
No underlying causes
|
| Rheum / Immune / Allergy
|
No underlying causes
|
| Sexual
|
No underlying causes
|
| Trauma
|
No underlying causes
|
| Urologic
|
No underlying causes
|
| Miscellaneous
|
No underlying causes
|
Causes in Alphabetical Order
Causes by Specific Allergic Reactions[1][2]
| Cutaneous reactions
|
Clnical features
|
Implicated medications
|
| Exanthems
|
▸ Delayed-type hypersensitivity
▸ Evolve over days after drug initiation
▸ Diffuse macules and papules
|
Allopurinol, amphotericin, barbiturates, captopril, carbamazepine, cephalosporins, chloramphenicol, erythromycin, furosemide, gentamicin, gold salts, lithium, nalidixic acid, nitrofurantoin, penicillins, phenothiazines, phenylbutazone, phenytoin, sulfonamides, thiazides
|
| Urticaria/ angioedema
|
▸ Often IgE mediated
▸ Onset within minutes of drug initiation
|
Abatacept, ACE inhibitors, Acyclovir, adalimumab, Albuterol, alendronate, alteplase, aminosalicylic acid, anticonvulsants, aspirin, atomoxetine, atropine, Benazepril, Budesonide And Formoterol Fumarate Dihydrate, Captopril, Carvedilol, Celecoxib, cephalosporins, eszopiclone, Exenatide, desvenlafaxine, dextran, darunavir, ipratropium bromide, quinidine sulfate, hydralazine, monoclonal antibodies, NSAIDs, opioids, penicillins, pentamidine, quinine, sitagliptin, sulfonamides, tetracyclines, tenofovir, thiouracil, ticlopidine, tubocurarine, ustekinumab, vancomycin, zolpidem
|
| Fixed drug eruption
|
▸ Hyperpigmented plaques that recur at same skin or mucosal site
|
ACE inhibitors, adalimumab, allopurinol, amlodipine, aspirin, barbiturates, benzodiazepines, carbamazepine, cephalosporins, clindamycin, co-trimoxazole, dextromethorphan, diltiazem, fluconazole, lamotrigine, lansoprazole, metronidazole, NSAIDs, paclitaxel, paracetamol, penicillin, phenolphthalein, omeprazole, quinine, salicylates, sulfonamides, terbinafine, tetracyclines, trimethoprim
|
| Pustules
|
▸ Acute generalized eczematous pustulosis or acneiform rash
|
antibiotics, calcium-channel blockers, corticosteroids, sirolimus
|
| Bullous
|
▸ Flaccid or tense blisters
|
Captopril, penicillamine, furosemide, vancomycin
|
| Cutaneous lupus erythematosus
|
▸ Erythematous/scaly plaques in photodistribution
|
Hydrochlorothiazide, calcium-channel blockers, ACEIs
|
| Stevens-Johnson syndrome (SJS)
|
▸ Purpuric macules on face and trunk with <10% epidermal detachment, fever, stomatitis, ocular involvement
|
Antibiotics, acyclovir, alendronate, atazanavir, barbiturates, Bendamustine, β-lactam antibiotics, Brinzolamide, carbamazepine, Carvedilol, Celecoxib, chlorpropamide, co-trimoxazole, darunavir, escitalopram, gold, H2 antagonists, histamine, lamotrigine, leflunomide, macrolides, mefloquine, NSAIDs, olmesartan Medoxomil-Hydrochlorothiazide, phenothiazines, phenytoin, rifampicin, sitagliptin, Sulfacetamide sodium And Prednisolone acetate, sulfonamides, tetracyclines, thiazides, ticlopidine
|
| Toxic epidermal necrolysis (TEN)
|
▸ Similar to SJS but >30% epidermal detachment
|
Acyclovir, alendronate, allopurinol, atazanavir, barbiturates, Bendamustine, Brinzolamide, carbamazepine, Celecoxib, escitalopram, gold, griseofulvin, lamotrigine, leflunomide, nitrofurantoin, NSAIDs, olmesartan Medoxomil-Hydrochlorothiazide, penicillins, phenytoin, salicylates, sitagliptin, Sulfacetamide sodium And Prednisolone acetate, sulfonamides, tetracyclines
|
| Organ-specific reactions
|
Clnical features
|
Implicated medications
|
| Pulmonary
|
▸ Pulmonary fibrosis, hypersensitivity pneumonitis
|
Nitrofurantoin, bleomycin, Cabergoline, Cetuximab, methotrexate
|
| Hepatic
|
▸ Hepatitis, cholestasis
|
Para-aminosalicylic acid, Brinzolamide, Sulfacetamide sodium And Prednisolone acetate, sulfonamides, phenothiazines
|
| Renal
|
▸ Interstitial nephritis, membranous glomerulonephritis
|
Penicillin, sulfonamides, gold, penicillamine, allopurinol
|
| Hematologic
|
▸ Hemolytic anemia, thrombocytopenia, granulocytopenia
|
▸ Hemolytic anemia — 5-Azacytidine, Acetophenazine, Aclarubicin, Actinomycin D, Albendazole, Alemtuzumab, Aminopyrine, Amitriptyline, Amodiaquine, Anakinra, Antipyrine, Azathioprine, Bevacizumab, Bortezomib, Captopril, Carbimazole, Caspofungin, Chloramphenicol, Chlorpromazine, Cidofovir, Cilazapril, Clofarabine, Clozapine, Deferiprone, Desipramine, Docetaxel, Dothiepin, Doxorubicin, Eflornithine, Ethosuximide, Ethotoin, Flucytosine, Fludarabine, Ganciclovir, Gemcitabine, Gold salts, Hydroxycarbamide, Hypersplenism, Ibritumomab tiuxetan, Idarubicin, Imatinib mesylate, Interferon alpha, Interferon beta, Irinotecan, Isoniazid, Levomepromazine, Mercaptopurine, Methimazole, Mirtazapine, Mitoxantrone, Nortriptyline, Paclitaxel, Penicillamine, Pentamidine, Pentostatin, Perazine, Phenylbutazone, Phenytoin, Pipothiazine, Procainamide, Propylthiouracil, Pyrimethamine, Quinidine, Remoxipride, Riluzole, Stiripentol, Sulfasalazine, Sulphonamides, Ticlopidine, Topotecan, Trastuzumab, Trimetrexate, Valganciclovir, Zidovudine, Zileuton
▸ Thrombocytopenia — Aldesleukin, Amobarbital, Amrinone, Capreomycin, Carboplatin, Cefotaxime, Cefotetan, Cefoxitin, Ceftizoxime, Chloramphenicol, Chlorpropamide, Cinoxacin, Claforan, Diabinese, Estrogens, Ethanol, Exna, Paraplatin, Phenylbutazone, Procainamide, Proleukin, Secobarbital, Sulfonamides, Thiazides, Tuinal
▸ Granulocytopenia — Benzthiazide, Bortezomib, Brinzolamide, Bumetanide, Capecitabine, Captopril, Ceftazidime, Celecoxib, Chlorpropamide, Dapsone, Diabinese, Exna, Fortaz, Penicillin, quinine, salicylate, Sulfacetamide sodium And Prednisolone acetate, sulfonamides
|
| Multiorgan reactions
|
Clnical features
|
Implicated medications
|
| Anaphylaxis
|
▸ Urticaria, angioedema, bronchospasm, gastrointestinal symptoms, hypotension
|
Albuterol, β-lactam antibiotics, Betaxolol, Bisoprolol, Bivalirudin, Bortezomib, Buprenorphine Hydrochloride, Naloxone Hydrochloride, monoclonal antibodies, adalimumab, Benazepril, Bendamustine, Captopril, Carteolol, Carvedilol, Celecoxib, epoetin alfa, Exenatide, Ibandronic acid, Insulin glargine, Interferon beta-1b, Nebivolol, Olmesartan, tinzaparin, triamterene, urokinase
|
| Systemic lupus erythematosus
|
▸ Arthralgia, myalgias, fever, malaise
|
Hydralazine, procainamide, isoniazid
|
| Vasculitis
|
▸ Cutaneous or visceral vasculitis
|
Allopurinol, aspirin, β-lactam antibiotics, carbamazepine, carbimazole, co-trimoxazole, diltiazem, erythromycin, furosemide, gold, G-CSF, GM-CSF, hydralazine, interferons, methotrexate, minocycline, NSAIDs, penicillamine, propylthiouracil, retinoids, sulfasalazine, sulfonamides, thiazides, thrombolytics
|
| Serum sickness
|
▸ Urticaria, arthralgia, fever
|
Heterologous antibodies, infliximab Cefdinir Bupropion Levothyroxine Moxifloxacin Tetracycline hydrochloride Antivenom Glatiramer acetate Antivenin Measles Ticlopidine Clopidogrel Novobiocin Epinephrine Omalizumab Rituximab Immunosuppressive drug Digoxin Levothyroxine Ciprofloxacin Cefprozil Cefaclor Oxacillin Amoxicillin Penicillin G benzathine Ampicillin Ceftibuten Cefpodoxime Terbinafine Gemifloxacin Metronidazole Cefadroxil Doxycycline Levofloxacin Minocycline Moxifloxacin Sulfadiazine Lincomycin Sulfamethoxazole
|
| Drug reaction with eosinophilia and systemic symptoms (DRESS)
|
▸ Cutaneous eruption, fever, eosinophilia, hepatic dysfunction, lymphadenopathy
|
Allopurinol, anticonvulsants, atazanavir, minocycline, sulfonamides
|
References